Teaching Cultural Sensitivity

Recently, Pearson has fallen under the scrutiny of the public as allegations of racism emerge. In an attempt to teach cultural sensitivity to the next generation of nurses, a recent textbook, “Nursing: A Concept-Based Approach to Learning”, described cultural discrepancies in response to pain which exhibited vast generalizations and stereotypes. (Read more here). The lack of accord of inter-individual differences was apparent in the generalizations presented. While this may not have been the right way to approach teaching cultural sensitivity, it drew light on the underlying issue of how to effectively teach cultural sensitivity in the healthcare setting.

The Committee on Health Care for Underserved Women emphasizes the potential positive impact on patient health with every health care encounter. This potential impact is maximized by healthcare provider’s awareness and attention to cultural differences in an effort to personalize care for their patients.

The Developmental Model of Intercultural Sensitivity (DMIS) is a theoretical model developed by Dr. Milton Bennett which describes the way in which we come to understand cultural differences. This theory is build upon the basis that as we are exposed to different cultures, we come to terms with the differences which exist and begin to accept and finally integrate them into our own identity and worldview. The theory presents the the following stages which we go through as we are exposed to the other cultures: Denial, Defense/ Reversal, Minimization, Acceptance, Adaption, and finally Integration. The goal which exists for individuals treating those of other cultures is that we reach what he refers to as an ethnorelative stage (which includes the stages of Acceptance, Adaption, and Integration) in a way that allows us to consider cultures different from our own. Specifically in the healthcare setting, this allows for personalization of care and promotion of holistic well-being.

So how do we practice/teach/learn cultural sensitivity in healthcare? Calling on AAA…

Awareness

Step 1: become more self-aware. Self-awareness of one’s own beliefs and attitudes towards healthcare and other cultures is an essential first step to practicing cultural sensitivity in one’s practice.

“’Caregivers are expected to be aware of their own cultural identifications in order to control their personal biases that interfere with the therapeutic relationship. Self-awareness involves not only examining one’s culture, but also examining perceptions and assumptions about the client’s culture.’ Developing this self-awareness can bring into view the caregivers biases or culturally-imposed beliefs. It can also shed light on oppression, racism, discrimination, and stereotyping and how these affect nurses personally and their work.” –Julie Ferwerda

Accepting

Step 2: accept the patient’s wishes and needs. Once you learn of other cultures, possibly one of the hardest things you must learn to do is accept the wishes of the patient for whatever reason they may be. In some cases, this may be contrary to what is “best” for their health and may make their condition worse or even lead to death, but you must respect their wishes. For example, some religions do not accept blood from other human beings or some may not accept organs from animals. This may be the “only” option for the patient, but you can not press the matter. You must demonstrate compassion and acceptance to patient’s decisions in all aspects regarding their care. (Adapted from Julie Ferwerda)

Asking

Step 3: if you don’t know…ask! This one cannot be emphasized enough. Who better to teach you about your patient’s personal preferences and cultural distinctions than the patient them-self? Having an open and honest discussion with your patients and asking them about their cultural beliefs in regard to healthcare can significantly promote care. However, it is important to note, while asking patients of their cultural needs and preferences may sound super straightforward, this can often seem like a very vague question and may thereby be overlooked. This is why we must emphasize that it is meant to be an open and honest discussion so as to allow the patient time to consider what you are asking and think of ways which their care experience could be enhanced in a personal manner. Assure the patient of your intention to personalize their care experience and encourage them to speak up if something comes to mind which would meet their cultural (or spiritual) needs. (Adapted from Julie Ferwerda)

Cultural sensitivity is something which is never truly “learned.” Mirko Prosen explains the importance of nurses viewing cultural competence as something they are always “becoming” and not yet “being,” regardless of the effort or time spent learning this personal aspect of care in his paper “Introducing Transcultural Nursing Education: Implementation of Transcultural Nursing in the Postgraduate Nursing Curriculum“. Cultural sensitivity is explored in regard to foreign language and culture, gender, sexual orientation, socioeconomic status, faith, profession, tastes, disability, age, as well as race and ethnicity. In this paper, he also talks of the holitic approach incorporating cultural awareness is to care. As appose to treating a condition, the person is treated with particular regard to their whole well-being. As health is defined as much more than physical wellness, and there is evidence of spiritual and mental wellness affecting physical health both positively and negatively, the emphasis on this cultural aspect of care is significant in promoting health and whole well-being.